Bellasi Antonio, Di Micco Lucia, Russo Domenico, De Simone Emanuele, Di Iorio Mattia, Vigilante Raffaella, Di Lullo Luca, Di Iorio Biagio Raffaele
Department of Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy.
Nefrology and Dialysis, Ospedale del Mare, ASL Napoli 1 Centro, 80147 Napoli, Italy.
J Clin Med. 2019 Jul 12;8(7):1026. doi: 10.3390/jcm8071026.
: The perturbation of phosphate homeostasis portends unfavorable outcomes in chronic kidney disease (CKD). However, the absence of randomized clinical trials (RCT) fuels the discussion of whether phosphate or some other phosphorous-related factor(s) such as fibroblast growth factor 23 (FGF-23) mediates the cardiovascular and systemic toxicity. We herein test whether the fractional excretion of phosphate (FeP) as a marker of renal stress to excrete phosphorous predicts unfavorable outcomes in CKD patients. Methods: Retrospective, cross-sectional observational study. For current analysis, an historical cohort of 407 records of CKD stage 3b-5 patients attending between January 2010 and October 2015 at the Nephrology Unit of Solofra (AV), Italy were utilized. Demographic, clinical, laboratory, and outcome data were identified through the subjects' medical records. We tested whether quartiles of FeP are associated with the risk of CKD progression or all causes of death. Parametric as well as non-parametric tests, linear and logistic regression, as well as survival analysis were utilized. Results: Overall, we investigated middle-age (mean 66.0, standard deviation 12.3 years) men and women (male 43%) with CKD stage 3b to 5 (creatinine clearance 32.0 (13.3) mL/min). Older age, lower diastolic blood pressure, poor renal function, as well as higher serum phosphate were associated with FeP. Patients with higher FeP were at an increased risk of starting dialysis or dying (hazard ratio 2.40; 95% confidence interval (1.44, 3.99)). Notably, when the two endpoints were analyzed separately, FeP was associated with renal but not all-cause survival. : FeP is associated with ESRD, but not all-cause mortality risk in a large cohort of moderate to advanced CKD patients. Future efforts are required to validate FeP as a marker of nephron stress and risk factor for CKD progression in this high-risk population.
磷酸盐稳态的紊乱预示着慢性肾脏病（CKD）患者预后不良。然而，由于缺乏随机临床试验（RCT），关于是磷酸盐还是其他一些与磷相关的因素（如成纤维细胞生长因子23，FGF - 23）介导心血管和全身毒性的讨论愈演愈烈。我们在此测试作为肾脏排泄磷压力指标的磷酸盐排泄分数（FeP）是否可预测CKD患者的不良预后。方法：回顾性横断面观察研究。本次分析使用了意大利索洛弗拉（阿韦利诺省）肾脏病科2010年1月至2015年10月期间收治的407例3b - 5期CKD患者的历史队列记录。通过受试者的病历确定人口统计学、临床、实验室和结局数据。我们测试了FeP四分位数是否与CKD进展风险或全因死亡相关。采用了参数检验和非参数检验、线性和逻辑回归以及生存分析。结果：总体而言，我们研究了年龄为中年（平均66.0岁，标准差12.3岁）的男性和女性（男性占43%），CKD分期为3b至5期（肌酐清除率32.0（13.3）mL/min）。年龄较大、舒张压较低、肾功能较差以及血清磷酸盐水平较高与FeP相关。FeP较高的患者开始透析或死亡的风险增加（风险比2.40；95%置信区间（1.44，3.99））。值得注意的是，当分别分析两个终点时，FeP与肾脏生存相关，但与全因生存无关。FeP与终末期肾病相关，但在一大群中重度CKD患者中与全因死亡风险无关。未来需要进一步努力验证FeP作为肾单位应激指标和CKD进展风险因素在这一高危人群中的作用。
